Respiratory Management in Guillain-Barré Syndrome

Introduction to Respiratory Failure

The American College of Physicians and other medical societies recommend intubation when vital capacity falls below 12-15 ml/kg, arterial PO2 drops below 60-70 mmHg, PaCO2 exceeds 50 mmHg, pH falls below 7.3, or clinical signs of respiratory fatigue appear, with a strength of evidence level not specified 1

A single breath count ≤19 (or <12 in some protocols) predicts the need for mechanical ventilation and should trigger preparation for intubation, based on moderate-quality evidence 1

Vital capacity measurements should be taken every 4-6 hours in deteriorating patients, as recommended by the American Thoracic Society, with a strength of evidence level not specified 1
Single breath count should be used as a bedside screening tool, with a strength of evidence level not specified 1
Use of accessory respiratory muscles should be monitored closely, with a strength of evidence level not specified 1
Arterial blood gases should be used if respiratory compromise is suspected, with a strength of evidence level not specified 1

Patients should be admitted to the ICU for evolving respiratory distress with imminent respiratory insufficiency, severe autonomic cardiovascular dysfunction, severe swallowing dysfunction or diminished cough reflex, or rapid progression of weakness, as recommended by the Society of Critical Care Medicine, with a strength of evidence level not specified 1

CPAP is appropriate for obstructive sleep apnea, heart failure, and some chronic neuromuscular conditions with stable respiratory insufficiency, but not for acute, rapidly progressive neuromuscular respiratory failure like GBS, according to the American Academy of Sleep Medicine and the Heart Failure Society of America, with a strength of evidence level not specified 2, 3